Giving a Mixed-Dose Insulin Shot to Children: Care Instructions

Overview

Insulin is normally made by the pancreas, a gland behind the stomach. In children with type 1 diabetes, the pancreas no longer makes enough insulin or it stops making it. Without insulin, your child's blood sugar level rises to dangerous levels. When this happens, your child needs insulin shots to keep blood sugar at a safe level. Sometimes your child may need two different types of insulin that are given in the same syringe. This is called a mixed-dose insulin shot.

You may be nervous giving your child a shot at first. But soon, giving the shot will become routine. It is quite easy to learn how to draw up insulin into a syringe and give the shot. The needles you use to give the insulin injections are very thin, and most children who have diabetes say that they do not even feel the needle enter the skin. Even if your child does feel the injection, the sting of the shot is not bad and does not last long. Many parents give their children shots. You can too.

How can you care for your child at home?

Getting started

• Gather your supplies. You will need an insulin syringe, your bottles of insulin, and an alcohol wipe or a cotton ball dipped in alcohol. Keep your supplies in a bag or kit so you can carry the supplies wherever you and your child go.
• Check the labels on the bottles and contents. Read and follow all instructions on the label, including how to store the insulin and how long the insulin will last.
• Wash your hands with soap and running water. Dry them well.

Preparing the shot

To prepare a mixed-dose insulin shot:

1. Roll the cloudy insulin bottle (vial) gently between your hands. Roll the cloudy insulin bottle until all the white powder has dissolved. Rolling the bottle warms the insulin if you have been keeping the bottle in the refrigerator. Do not shake an insulin bottle.
2. Clean the lids of the bottles. If you are using a bottle for the first time, remove the protective cover from the rubber lid. If the rubber lid of the insulin bottle is dirty, clean it with an alcohol wipe or a cotton ball dipped in alcohol. Let the alcohol dry.
3. Draw air into the syringe for the cloudy insulin dose.
   1. Remove the plastic cap that covers the needle on your insulin syringe. Important: Do not touch the needle.
   2. Pull the plunger back on your insulin syringe and draw air into the syringe equal to the number of units of cloudy insulin to be given.
4. Force air into the cloudy insulin bottle.
   1. Push the needle of the syringe into the rubber lid of the cloudy insulin bottle.
   2. Push the plunger of the syringe to force the air into the bottle. This equalizes the pressure in the bottle when you later remove the dose of insulin.
   3. Remove the needle from the bottle.
5. Draw air into the syringe for the clear insulin dose. Pull the plunger of the syringe back and draw air into the syringe equal to the number of units of clear insulin to be given.
6. Force air into the clear insulin bottle.
   1. Push the needle of the syringe into the rubber lid of the clear insulin bottle. Note: You will draw the clear insulin into the syringe first, then the cloudy insulin (Step 8). It is important to follow this order.
   2. Push the plunger to force the air into the bottle. Leave the needle in place.
7. Draw clear insulin into the syringe.
   1. Turn the bottle and syringe upside down. Position the tip of the needle so that it is below the surface of insulin in the bottle.
   2. Pull back the plunger to fill the syringe with slightly more than the correct number of units of clear insulin to be given.
   3. Tap the barrel of the syringe so that trapped air bubbles move into the needle area. Push the air bubbles back into the bottle. Important: Make sure that you have the correct number of units of insulin in your syringe.
   4. Remove the needle from the clear insulin bottle.
8. Insert the needle into the cloudy insulin bottle. Insert the needle into the rubber lid of the cloudy insulin bottle. Important: Do not push the plunger because this would force clear insulin into your cloudy insulin bottle. If clear insulin is mixed in the bottle of cloudy, it will alter the action of your other doses from that bottle.
9. Draw cloudy insulin into the syringe.
   1. Turn the bottle and syringe upside down. Position the tip of the needle so that it is below the surface of insulin in the bottle.
   2. Slowly pull back the plunger of the syringe to fill the syringe with the correct number of units of cloudy insulin to be given. This will prevent air bubbles entering the syringe.
   3. Remove the needle from the bottle. You should now have the total number of units for the clear and cloudy insulin in your syringe. For example, if you need 10 units of clear and 15 units of cloudy, you should have 25 units in your syringe. Now you are ready to give the shot.

Giving your child the shot

1. If you use alcohol to clean your child's skin before you give the shot, let it dry.
2. Slightly pinch a fold of skin between your fingers and thumb of one hand.
3. Hold the syringe like a pencil close to the site, keeping your fingers off the plunger. It is usually recommended to place the syringe at a 90-degree angle to the shot site, standing straight up from the skin.
4. Bend your wrist, and quickly push the needle all the way into the pinched-up area.
5. Push the plunger of the syringe all the way in so the insulin goes into the fatty tissue.
6. Take the needle out at the same angle that you inserted it. If your child bleeds a little, apply pressure over the shot area with your finger, a cotton ball, or a piece of gauze. Do not rub the area.
7. Replace the cover over the needle, and dispose of the needle safely. Do not use the same needle more than one time.

Where to give the shot

You can inject insulin at a few places on the body. These places include:

• The belly, but at least 2 inches from the belly button. This is thought to be the best place to inject insulin.
• The top outer part of the thighs. Insulin usually is absorbed more slowly from this site, unless your child exercises soon after getting the shot.
• The outside of the upper arms or the buttocks.

Your doctor may advise you to give the shots in different places on your child's body each day. This is called site rotation. Make sure you talk to the doctor about how to do this safely. If you rotate sites, use the same site at the same time of each day. For example, each day:

• At breakfast, give the shot in one of your child's arms.
• At lunch, give the shot in one of your child's legs.
• At dinner, give the shot in your child's belly.

Slightly change the spot where you give an insulin shot each time you do it. For example, use five different places on the right upper arm, then use five places on the left upper arm. Using the same spot every time can cause bumps or pits in the skin and make the shots hurt more. It may also slow down how the insulin is absorbed into your child's body.